Needlestick Injury and Infection

Risk of Developing Infection from a Hollow Needle Puncture

Hepatitis B Virus (HBV) 30%
Hepatitis C Virus (HCV) 3%
HIV 0.3%

Gastric Ulcer vs Duodenal Ulcer

Gastric Ulcer

-more frequent in older patient, male:female 1:1
-epigastric pain
-food intake exacerbates pain
-patient tends not to eat --> weight loss
-risk of cancer (always perform biopsy!!)

Duodenal Ulcer

-more frequent in younger patient, male:female 3:1
-pain in right umbilical area(duodenal area)
-vomiting tend to relieve pain
-pain more frequent during hunger/night time/early morning
-food intake relieves pain
-patient tends to eat more --> no weight loss or weight gain
-lower risk of cancer
-bleeding more frequent (more ulcers)

Drug treatment for tuberculosis

Rifampin is the drug of choice for treatment; in most cases, the treatment duration is at least 18 months without rifampin

Ethambutol (EMB) is used to prevent rifampin resistance if the organism is resistant to isoniazid (INH); EMB can be discontinued as soon as the organism is found to be susceptible to rifampin and INH.

Pyrazinamide is used for the first 2 months of treatment to decrease the treatment duration from 9 months to 6 months if the organism is susceptible to rifampin and INH

Urine alkalinisation

1. Salicylate poisoning
- recommended in all symptomatic patients with regard of hypokalemia (common in salicylate poisoning)
- Diamox should NEVER be used as for acidemia and subsequent increased toxicity
- Urinary alkalinization by PO NaHCO3 enhances the elimination of weak acids: salicylates, phenobarbital, chlorpropamide, chlorophenoxy herbicides, formic acid, and methotrexate

2. Pure uric acid stones
- dissolved with oral alkalinization, K citrate, Na bicarbonate --> urinary pH 6.5-7

3. Rhabdomyolysis
- IV bicarbonate

4. Hemoglobinuria (heatstroke)